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K68.19 ICD-10-CM Code: Other retroperitoneal abscess

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 33

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 371 — MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC (MDC 06)
  • MS-DRG 372 — MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC (MDC 06)
  • MS-DRG 373 — MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC (MDC 06)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 78 — Intestinal Obstruction/Perforation

Other models: CMS-HCC V22 HCC 33

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coder workflow for K68.19

MedCoder structured workflow — derived from this code’s own official record

Before you code K68.19

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on K68.19; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewK68.11, K68.12

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Other retroperitoneal abscess is a billable ICD-10-CM diagnosis code (K68.19).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Chapter 11: Diseases of the Digestive System (K00-K95)

Reserved for future guideline expansion

Verify Before Coding

  • MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name K68.19 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: K65 — Peritonitis (via K68.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: K6A.0 — Pelvic abscess (via K68.1.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 22 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 371 (MDC 06), DRG 372 (MDC 06), DRG 373 (MDC 06), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):DIG016 — Peritonitis and intra-abdominal abscess (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

K63.8211 — Small intestinal bacterial overgrowth, hydrogen-subtype, K63.8212 — Small intestinal bacterial overgrowth, hydrogen sulfide-subtype, K63.8219 — Small intestinal bacterial overgrowth, unspecified, K63.822 — Small intestinal fungal overgrowth, K63.829 — Intestinal methanogen overgrowth, unspecified, K63.89 — Other specified diseases of intestine, K63.9 — Disease of intestine, unspecified, K65.0 — Generalized (acute) peritonitis, K65.1 — Peritoneal abscess, K65.2 — Spontaneous bacterial peritonitis, K65.3 — Choleperitonitis, K65.4 — Sclerosing mesenteritis, K65.8 — Other peritonitis, K65.9 — Peritonitis, unspecified, K68.2 — Retroperitoneal fibrosis, K68.3 — Retroperitoneal hematoma, K68.9 — Other disorders of retroperitoneum, K92.89 — Other specified diseases of the digestive system, K92.9 — Disease of digestive system, unspecified, R11.13 — Vomiting of fecal matter, +1 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Intestinal Obstruction/Perforation) for risk-adjusted payment.

K63.1 — Perforation of intestine (nontraumatic), K65.0 — Generalized (acute) peritonitis, K65.1 — Peritoneal abscess, K65.2 — Spontaneous bacterial peritonitis, K65.3 — Choleperitonitis, K65.4 — Sclerosing mesenteritis, K65.8 — Other peritonitis, K65.9 — Peritonitis, unspecified, K67 — Disorders of peritoneum in infectious diseases classified elsewhere, K68.12 — Psoas muscle abscess, P77.1 — Stage 1 necrotizing enterocolitis in newborn, P77.2 — Stage 2 necrotizing enterocolitis in newborn, P77.3 — Stage 3 necrotizing enterocolitis in newborn, P77.9 — Necrotizing enterocolitis in newborn, unspecified, P78.0 — Perinatal intestinal perforation, Q40.0 — Congenital hypertrophic pyloric stenosis, Q41.0 — Congenital absence, atresia and stenosis of duodenum, Q41.1 — Congenital absence, atresia and stenosis of jejunum, Q41.2 — Congenital absence, atresia and stenosis of ileum, Q41.8 — Congenital absence, atresia and stenosis of other specified parts of small intestine, +55 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Intestine Transplant Status/Complications

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Peritonitis and intra-abdominal abscess).

K61.0 — Anal abscess, K61.1 — Rectal abscess, K61.2 — Anorectal abscess, K61.3 — Ischiorectal abscess, K61.31 — Horseshoe abscess, K61.39 — Other ischiorectal abscess, K61.4 — Intrasphincteric abscess, K61.5 — Supralevator abscess, K63.0 — Abscess of intestine, K65.0 — Generalized (acute) peritonitis, K65.1 — Peritoneal abscess, K65.2 — Spontaneous bacterial peritonitis, K65.3 — Choleperitonitis, K65.4 — Sclerosing mesenteritis, K65.8 — Other peritonitis, K65.9 — Peritonitis, unspecified, K67 — Disorders of peritoneum in infectious diseases classified elsewhere, K68.11 — Postprocedural retroperitoneal abscess, K68.12 — Psoas muscle abscess, K75.0 — Abscess of liver, +32 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Abscess”; these codes share that main term but sit in a different category of the Tabular List.

K57.81 — Diverticulitis of intestine, part unspecified, with perforation and abscess with bleeding (with, diverticular disease, with bleeding), K61.0 — Anal abscess (anus), K61.1 — Rectal abscess (rectum), K61.2 — Anorectal abscess (anorectal), K61.31 — Horseshoe abscess (horseshoe), K61.39 — Other ischiorectal abscess (ischiorectal), K61.4 — Intrasphincteric abscess (intersphincteric), K61.5 — Supralevator abscess (supralevator), K63.0 — Abscess of intestine (colon), K65.1 — Peritoneal abscess (omentum), K6A.01 — Prevesical abscess (retropubic), K6A.09 — Other pelvic abscess (pelvis, pelvic), K75.0 — Abscess of liver (liver), K81.0 — Acute cholecystitis (gallbladder), K94.02 — Colostomy infection (colostomy), K94.12 — Enterostomy infection (ileostomy), L02.01 — Cutaneous abscess of face (chin), L02.11 — Cutaneous abscess of neck (neck), L02.211 — Cutaneous abscess of abdominal wall (loin), L02.212 — Cutaneous abscess of back [any part, except buttock and flank] (back), +157 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Gamma-glutamyl Transferase (GGT) Test

Contextual Map

Every relationship of K68.19 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run K68.19 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

  • K65 — Peritonitis[Excludes1](via K68.-): “retroperitoneal infections (K68.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

  • K6A.0 — Pelvic abscess[Excludes2](via K68.1.-): “retroperitoneal abscess (K68.1-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 78 — Intestinal Obstruction/Perforation [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 06 — Diseases and Disorders of the Digestive System[MDC crossing]: “Diseases and Disorders of the Digestive System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,744 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic), extraperitoneal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic), presacral[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic), retroperitoneal NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "K68.19 — Other retroperitoneal abscess." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/k68.19-other-retroperitoneal-abscess

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other retroperitoneal abscess

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K68.19 in its code family, with their registry titles.

View all codes in the K68 family